How should asthma be managed during pregnancy or IVF?

Question

Hello doctor,

I am writing for my niece, who has moderate persistent asthma and is now planning for her first child. She is on a combination inhaler (Budesonide-Formoterol) and sometimes uses oral steroids during flare-ups. She is anxious about whether these meds are safe if she conceives.

Could they affect the baby or lead to complications during pregnancy? Her asthma worsens during her periods.
Is there a hormonal connection we should be aware of?
Would birth control help stabilize her symptoms or worsen them?
Are there any specific guidelines for managing asthma during IVF or pregnancy?
Also, how should we prepare for labor and delivery in an asthmatic woman?
Does she need special precautions? Would breastfeeding be affected by asthma medications?
She has also heard that hormonal changes during pregnancy might either improve or worsen asthma. How predictable is that?

We just want to make sure she stays stable while planning a family.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

During pregnancy, asthma (a chronic respiratory disease characterized by inflammation, muscle tightening, and mucus production that narrows airways, causing wheezing, coughing, and shortness of breath) attacks are increased. Inhaled bronchodilators and corticosteroids are considered safe during pregnancy.

For an acute exacerbation, the addition of IV (intravenous) Methylprednisolone, followed by oral Prednisone.

Pregnancy does not usually change the treatment of asthma. Women are taught strategies to help manage asthma, including minimizing exposure to triggers and serially measuring pulmonary function (usually with a handheld peak flow meter).

Inhaled bronchodilators and corticosteroids are first-line maintenance therapy for asthma in pregnant women. Budesonide is the preferred inhaled corticosteroid. Based on available data, inhaled Budesonide does not appear to increase the risk of congenital (birth) malformations in humans.

For an acute exacerbation, in addition to bronchodilators, Methylprednisolone 60 mg IV (intravenous) every six hours for 24 to 48 hours may be used, followed by oral Prednisone in a tapering dose. Women who are currently receiving or have recently required systemic corticosteroids should receive intravenous corticosteroids during labor and for 24 hours after delivery to prevent adrenal crisis.

In addition, you should start taking Folic acid 5 mg once daily at night from the preconception period and continue until the first three months of pregnancy.

You are advised to:

Consult a gynecologist for pregnancy planning and follow-up.
Undergo a dating scan at seven to nine weeks.
Have an NT (nuchal translucency, a first-trimester ultrasound) scan between 11 and 13+6 weeks.
Get an anomaly scan (a pregnancy ultrasound to check if the baby is growing normally and has no major problems) between 18 and 20 weeks.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.